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Is your hospital a great place to work?

Here are factors that drive doctors out

December 2015

Published in the December 2015 issue of Today’s Hospitalist

THIS SUMMER, I read a Wall Street Journal article about the Good Jobs Index developed by Zeynep Ton, DBA. Who is Zeynep Ton? She is a professor at MIT’s Sloan School of Management who has ranked retailers on employee happiness. It was so positive to read about businesses concerned about employee happiness and not just about profits and shareholders.

But two weeks later, I was dismayed to see the New York Times article about the bruising work environment at Amazon. That article described a culture that is toxic to workers and overseen by a CEO who chooses to stay blind to the consequences.

I work in a hospital, and I was curious: Are hospitals ranked according to employee happiness? My health system “Meridian Health, which is based in Wall Township, N.J. “is recognized as a Great Place to Work by Great Place to Work, a business consulting firm. It was also named in this year’s Fortune Magazine’s “100 Best Companies to Work For.

Top-down management will ensure that your hospital is never nominated as a great place to work. 

However, I’ve worked in many hospitals over my career, and my experiences at some were closer to the abusive atmosphere the New York Times detailed in its article on Amazon. I imagine those old workplaces of mine could continue avoiding accolades from their employees by following these 14 steps:

1. Ensure top-down management. You cannot have middle managers like department chairs speaking on behalf of doctor employees. Instead, have those chairs just spread edicts from higher-ups down to the masses, while upper management remains uninterested in employee concerns.

2. Make sure there is no doctors’ lounge. That would only encourage restless employees to congregate and complain about management and the system.

3. Orchestrate quarterly staff meetings to be about only the CEO and to air upper management decisions that have already been made for physician employees. Pretend to listen to employee concerns but remember: The meeting is really about only those at the top.

4. When any employed physician complains of burnout, use this response: You are welcome to leave, and you are replaceable.

5. Make sure that performance measures “which determine reimbursement and bonuses “are impossible to reach. By withholding financial bonuses from doctors, think of all the savings the system will accrue.

6. Focus on irrelevant metrics that will frustrate your employees. After all, caring really can’t be measured or quantified.

7. Don’t side with doctors who stand up to patients by refusing to overprescribe narcotics or to use antibiotics for viral illness. Then, when those doctors get poor patient reviews, make sure you single them out to demean them. After all, great patient reviews are more important than providing great medical care.

8. Each year, have the hospital demand greater productivity from its employed physicians. And when doctors ask for more resources, support staff or extra clinic time, tell them this is impossible because of expenditure cuts.

9. Take away coffee in the nurses lounge’ in the OR to save the hospital money. That will have little effect on staff morale.

10. Brag that your CEO is a physician like many thousands of his employees. But make sure those employees know the CEO is being paid 40 times their average salary.

11. Remind your doctors that it’s more about numbers and quotas than patient care. Let them know that if they do not meet RVU production targets, their job is at risk.

12. Find a graceless way to get rid of doctors when they reach their 60s. After all, experience and wisdom are easily overrated, and younger docs are cheaper to hire.

13. Have managers set work-life standards by making it OK for them to ignore their spouse and children and spend as much time as possible at work. Encourage workers to view the system as more important than family and to see the hospital as their family, 12-plus hours a day.

14. When doctors quit, don’t perform exit interviews. You really don’t care to know why they’re leaving, so just show them the way out.

The lesson I learned was that I have to work in a great place, one that cares about its employees. And if you are not in that great place, then leave.

Robert Khoo, MD,
 is medical director of colon and rectal surgery at the Southern Ocean Medical Center in Manahawkin, N.J. Dr. Khoo writes the “Social Media and Surgery” blog (doctorsocialmed.com), where this was originally published.